Healthcare Provider Details

I. General information

NPI: 1902993710
Provider Name (Legal Business Name): EAST COAST MEDICAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 11/02/2022
Certification Date: 11/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22545B HWY 17 N
HAMPSTEAD NC
28443
US

IV. Provider business mailing address

22545B HWY 17 N
HAMPSTEAD NC
28443
US

V. Phone/Fax

Practice location:
  • Phone: 910-329-0300
  • Fax: 910-329-0307
Mailing address:
  • Phone: 910-329-0300
  • Fax: 910-329-0307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number39512
License Number StateNC

VIII. Authorized Official

Name: LISA KAY YOCUM
Title or Position: OWNER
Credential: PA-C
Phone: 910-329-0300